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| |Effective Date: June 5, 2014 |

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|Category: Clinical |

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|Title: Arterial Puncture Procedure (Blood Gas) |

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|Applies to: |

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|St. Peter’s Health Partners (SPHP) |

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|All SPHP Component Corporations |

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|The following SPHP Component Corporations: |

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|___St. Peter’s Hospital____ |

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|St. Peter’s Health Partners Medical Associates (SPHPMA) |

TABLE OF CONTENTS

PURPOSE 1

POLICY STATEMENTS 1

SCOPE OF AUTHORITY / COMPETENCY 1

PROCEDURE 2

Preparation 2

Specimen Collection 3

LINKS

Hand Hygiene

Patient Identification

Standard Precautions

Mosby's Nursing Skills - Arterial Puncture

NICU – Radial Arterial Puncture by RN

REFERENCES 4

Top of Form

PURPOSE

To outline the process of arterial puncture.

POLICY STATEMENTS

• A physician/provider order is required for all arterial punctures.

• If one Respiratory Therapist cannot get a sample after two attempts, another Respiratory Therapist should be asked to attempt the arterial puncture.

SCOPE OF AUTHORITY / COMPETENCY

Respiratory Therapist (*Physician/Provider Order Required)

All RT's should demonstrate competency in the procedure under supervision of an experienced RT preceptor or RT Manager.

PROCEDURE

Indications

• Evaluation of the adequacy of ventilatory, acid-base, oxygenation status, and the oxygen-carrying capacity of blood.

• The need to quantify a patient’s response to therapeutic interventions (e.g.: BiPAP, oxygen therapy, mechanical ventilator).

• Diagnostic evaluation (e.g.: oxygen therapy, exercise testing).

• Monitoring the severity and/or progression of a documented disease process.

Precautions/Complications

• Arterial puncture should not be performed through a lesion or distal to a surgical shunt (dialysis)

• Hematoma

• Arteriospasm

• Trauma to the vessel

• Pain

• Inadvertent needle stick (use only arterial sampling kit with proactive sheath needles)

Equipment Required

• Adults: Arterial Puncture Kit

• Infants and children: 1 mL heparinized arterial blood sampling syringe with vented cap, 23 or 25g butterfly needle, alcohol prep pad, betadine prep pad, 2x2 gauze, and band aid or paper tape.

• Laboratory Requisition slip

• Patient labels

• Biohazard specimen bag

• Ice (if specimen cannot be transported to the lab within 15 minutes of acquisition)

Preparation:

|Steps |Key Points |

|Verify physician/provider order |Order should state: |

| |Date of the order |

| |Time of the order |

| |If the specimen should be collected with the patient on a specific oxygen |

| |flow rate, ventilator settings, etc. |

| |Physician/provider name |

|Review coagulation studies i.e., ACT, PT, PTT, INR and/or |Normal coagulation studies decreases bleeding complications. |

|platelets. Check to see if patiet is on anticoagulant therapy. | |

| |Note: Patients on anticoagulant therapy may need extra time to hold site.|

|Check patient’s ID band & verify identity using 2 patient |To ensure test is performed on the correct patient. Patient Identification|

|identifiers. | |

|Explain procedure to patient. |Reduces anxiety. |

|Perform proper Hand Hygiene and don clean gloves. |Follow all appropriate infection control and universal precautions. |

| |Standard Precautions |

|Position patient for comfort. |Facilitates insertion. |

|Perform Modified Allen’s Test: |If patient fails the Modified Allen’s Test on one hand, perform Modified |

|Hold firm pressure on both radial and ulnar artery. |Allen’s Test on the opposite hand. |

|Have patient open and close the hand that pressure is applied. |If patient fails both Modified Allen’s Tests, proceed to assess brachial |

|Have patient open hand while releasing pressure on the ulnar |arteries only if test is critically warranted. |

|artery. | |

|After pressure on the ulnar artery is released, the hand should| |

|become pink within 6 seconds. | |

|Note: Effective collateral circulation may be assessed with | |

|Doppler device. | |

Specimen Collection:

|Steps |Key Points |

|Place patient’s arm palm up. |Facilitates artery position. |

|Place patient’s arm on wrist support. |May need to hyper-extend wrist. |

|Don clean gloves. |Follow all appropriate infection control and universal precautions. |

| |Standard Precautions |

|Prepare site with betadine solution/alcohol. |Allow each agent to dry before going to next step. |

|Locate artery using non-dominate hand |Palpate artery with index and middle fingers. |

| | |

| |Note: May use Doppler device to assist in locating artery in conditions |

| |of severe hypotension. |

|Slowly perform puncture at approx. 45( angle. |Proper angle facilitates successful procedure. |

|Look for flash in needle hub and hold steady until syringe |Note: Approximately 0.5 mL of blood is needed for testing. |

|fills. | |

|Withdraw syringe and immediately close the safety cap. Apply |Hold pressure no less than 5 minutes. |

|firm pressure to site. |Assure that bleeding has stopped. |

| |If bleeding persists continue to hold pressure and dress with a pressure |

| |bandage. |

|Remove closed needle and place vented cap on syringe. Press on |To expel air bubbles. |

|the plunger until blood fills the gap in syringe hub and cap. | |

|Gently roll sample to mix the heparin with the blood. |To prevent clot formation. |

|Place patient label on specimen & complete laboratory |Verify correct label and requisition slip. |

|requisition slip. | |

| |Note: Make sure to include the patient’s temperature if less than 36.11( |

| |C (97( F) or greater than 38.33( C (101(F). |

| | |

| |Proper specimen labeling includes: |

| |Label affixed to the specimen with: |

| |patient name |

| |DOB |

| |collectors initials |

| |date & time of collection |

| |ABG requisition slip, filled in completely, inclusive of: |

| |patient name |

| |DOB |

| |specimen type |

| |collection site |

| |O2 / ventilation mode and applicable settings |

| |Modified Allen’s test if applicable |

| |collectors initials |

| |date & time of collection |

|Send specimen to the Blood Gas Lab for analysis. |Place the specimen on ice if it cannot be transported to the lab within 15|

| |minutes of acquisition |

REPORTABLE CONDITIONS TO PHYSICIAN/PROVIDER

• Any adverse events associated with procedure.

• Inability to successfully obtain sample.

DOCUMENTATION

Laboratory requisition slip:

• Patient name & date of birth

• Specimen type (arterial, mixed venous, venous)

• Specimen draw site

• FiO2

• Mode of ventilation/oxygenation and related settings

• Time & date of collection

• RT’s initials

Specimen label/Patient label:

• Time & date of collection

• RT’s initials

Progress notes section of patient chart:

• Adverse events, patient refusal, or inability to obtain a sample & notification of physician/provider

• Results of the Modified Allen’s Test

REFERENCES

American Association for Respiratory Care. (2012). Clinical Practice Guideline: Sampling for arterial blood gas analysis. Retrieved on May 15, 2012 from

Brzezinski M, Luisetti T, London MJ. (2009) Radial artery cannulation: a comprehensive review of recent anatomic and physiologic investigations. Anesthesia & Analgesia, 109(6):1763-81.

Mosby’s Nursing Skills (2011) Skill – Arterial Puncture

Shelly P. D., Hillmer, M.D., and Ferri, M. (2011) Arterial Puncture for Blood Gas Analysis. New England Journal of Medicine, 364:e7.

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|Approving Official: CNO; CMO | |Effective Date: June 5, 2014 |

| | | |

|Key Sponsor: Respiratory Therapy Manager | | |

| | |Original Date: 9/99 |

|Reviewed By: Director of Patient Therapies; chief of Pulmonary Medicine; Respiratory | |Reviewed/Revised Date: 9/02; 1/03; 10/08; 2/09; 5/12; 6/5/14|

|Therapists; SPH Policy Council | | |

| | |*Reviewed, No Revisions |

| | |**Revised without Full Review |

| | | |

|Search Terms: Arterial puncture, coagulation, Allen’s Test, ABG, oxygen, CO, Respiratory | | |

|Therapy | | |

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|Replaces: Arterial Puncture Procedure (Blood Gas), 5/12 |

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